• Archives of Reconstructive Microsurgery
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• 제15권1호
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• pp.10-16
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• 2006

We retrospectively evaluated our results of replantations of distal digital amputations and analyzed the factors deterrent to the survival of replanted digits. From January 2004 to 2005 June, we performed 101 cases of replantations following complete amputations at or distal to interphalangeal joint level. The study included 98 patients with a mean age of 35.6 years (range 1 to 63 years). Amputation level correlated to zone I (distal to the lunula)in 47 cases and zone II (lunula to distal interphalangeal joint) in 54 cases according to Yamano's classification. According to the mechanism of amputation, 24 cases (22.9%) suffered from guillotine type injury, 27 cases (27.1 %) from avulsion type injury and 50 cases (50%) from crush type injury. In all cases, a single arterial anastomosis was performed. Venous anastomosis on either volar or dorsal side was performed in 12 cases of amputation in zone II. Salvage procedure for venous drainage was performed in 98 cases. The mean duration of salvage procedures was 5.9 days (ranging from 4 to 14 days). Successful replantation was achieved in 96 cases (95.1%), which included 93.7% cases in zone I amputations and 96.3% cases in zone II amputations. A single venous anastomosis was performed in 12 cases of amputation in zone II. All of them survived completely. Among the 5 cases that failed to survive, 3 cases were related with avulsion injury in zone I. Initial mechanism of injury determines the survival rate of amputated parts as it is directly related with the status of vessels and soft tissues. Meticulous precaution during the salvage procedure may affect the overall survival rate of distal digital replantations.

• Journal of Chest Surgery
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• 제28권12호
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• pp.1174-1177
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• 1995

We experienced one case of TAPVC patient who was 39 years old man with mild dyspnea on exertion and easy fatigability. He was the oldest patient among TAPVC which was reported in Korea. Preoperative echocardiogram, cardiac catheterization and angiogram revealed supracardiac type TAPVC drained through left innominate vein. An anastomosis between common pulmonary venous trunk and left atrium, pericardial patch closure of ASD and ligation of left vertical vein were performed with extracorporeal circulation. The postoperative course was uneventful and discharged with excellent general condition and has been well during 8 months follow-up.

• 대한두개안면성형외과학회지
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• 제16권3호
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• pp.143-146
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• 2015

In this report, we present a scalp defect reconstruction with lateral arm free flap. We highlight the difficulty in obtaining a recipient vein and the venous drainage managed through an open end of the donor vein. A 52-year-old woman presented with a pressure sore on the left scalp. A lateral arm free flap was transferred to cover this $8{\times}6cm$ defect. The arterial anastomosis was successful, but no recipient vein could be identified within the wound bed. Instead, we used a donor venous end for the direct open venous drainage. In order to keep this exposed venous end patent, we applied heparin-soaked gauze dressing to the wound. Also, the vein end was mechanically dilated and irrigated with heparin solution at two hour intervals. Along with fluid management and blood transfusion, this management was continued for the five days after the operation. The flap survived well without any complication. Through this case, we were able to demonstrate that venous congestion can be avoided by drainage of the venous blood through an open vessel without the use of leeches.

• 대한수의학회지
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• 제11권1호
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• pp.83-90
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• 1971

The studies were conducted to ramify the splenic trabecular veins by injection of vinylite into the splenic veins in twenty five adult Korean cattle. The following results were obtained. 1. Splenic trabecular veins of bovine were collected from 3 chief Rami lienales: Rr. superior, inferior and V. polaris superior of the splenic veins, and the splenic parenchyma was ramified to 5-11 intralienal venous segments by the course of the trabecular veins. 2. Each one of the intralienal venous segments was dealt with 2-4 minute segments therefore, the splenic parenchyma was ramified from 13 minute segments in minimum to 35 minute segments in maximum. 3. The distribution of the veins in the spleen was divided into 7 types by the number of intralienal venous segment, and also was 15 kinds by collecting veins, Rr. superior et inferior and V. polaris superior. 4. The anastomosis was observed in the intralienal venous segments or minute segments. 5. Generally the splenic veins and arteries were like each other, but when observed minutely, they were unlike.

• Bulletin of the Korean Chemical Society
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• 제34권6호
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• pp.1663-1667
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• 2013

Neointimal hyperplasia causes vascular access dysfunction in hemodialysis patients with synthetic arteriovenous (AV) grafts. Several studies have reported that paclitaxel- or sirolimus-eluting AV grafts inhibit neointimal hyperplasia and display lower rates of stenosis compared with control grafts. However, there have been few comparative studies of the efficacy of paclitaxel- and sirolimus-eluting grafts. We compared the neointimal hyperplasia of paclitaxel- and sirolimus-eluting grafts. AV grafts were implanted laterally between the common carotid artery and the external jugular vein in 12 female Landrace pigs. The animals were sacrificed six weeks after surgery. The neointimal hyperplasia at the anastomosis sites of the grafts was quantified using the ratio of the intragraft hyperplasia to the graft area (H/G ratio) at the graft-vessel interface. The area of intimal hyperplasia at the venous (paclitaxel 1.06 [0.72-1.56] vs sirolimus 2.40 [1.72-3.0] $mm^2$, P = 0.04) and arterial anastomosis sites (paclitaxel 0.93 [0.57-1.48] vs sirolimus 2.40 [1.72-3.0] $mm^2$, P = 0.04) was significantly different between the two groups. However, the H/G ratios for the venous anastomosis site (paclitaxel 0.25 (0.17-0.38) vs sirolimus 0.38 (0.2-0.66), P = 0.4) and the arterial anastomosis site (paclitaxel 0.19 (0.08-0.39) vs sirolimus 0.41 (0.34-0.50), P = 0.1) did not differ significantly between the groups. In conclusion, there was no significant difference in the inhibition of neointimal hyperplasia by sirolimus- and paclitaxel-eluting AV grafts.

• Archives of Reconstructive Microsurgery
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• 제13권1호
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• pp.74-81
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• 2004

This study was designed to introduce the cross-leg free flap only for vein anastomosis as an alternative salvage method for the reconstruction of severe soft tissue defects in vascular-compromised lower extremities. Four cross-leg free flap reconstructions were performed using the latissimus dorsi muscle to reconstruct soft tissue defects in the lower extremity. The recipient artery was confined to the ipsilateral side and the venous anastomosis was carried out in the contralateral side. Both legs were immobilized together with an external fixator. All patients were males, and had a mean age of 31 years. The mean time of pedicle division was 8.8 days range of 7 to 10 days. The mean size of the flap was 186.5 cm2. All flaps survived after pedicle division without venous congestion. There was no complication in joint stiffness, nor donor site morbidity except for a linear scar. The cross-leg free flap only for vein anastomosis is a refinement of a salvage procedure used for the reconstruction of severe soft tissue defects in vascular-compromised lower extremities.

• Archives of Plastic Surgery
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• 제51권1호
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• pp.87-93
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• 2024

This study aimed to analyze cases of anterolateral thigh (ALT) free flap used for hand reconstruction with terminal perforator-to-digital artery anastomosis. Patients who underwent ALT free flap placement with terminal perforator-to-digital artery anastomosis for hand reconstruction between January 2011 and August 2021 were included. The number, length, and diameter of the perforators and veins, flap size, and operative time were investigated through a retrospective review of charts and photographs. The occurrences of arterial thrombosis, venous thrombosis, arterial spasm, and flap necrosis were analyzed. In total, 50 patients were included in this study. The mean diameter and length of the perforators were 0.68 mm and 3.25 cm, respectively, and the mean number of veins anastomosed was 1.88, with a mean diameter of 0.54 mm. Complications included four cases of arterial thrombosis, one case of venous thrombosis, seven cases of partial necrosis, and one case of total flap failure. Regression analysis showed that a longer perforator was associated with arterial thrombosis whereas larger flap size and number of anastomosed veins were associated with partial necrosis (p < 0.05). The terminal perforator-to-digital artery anastomosis offers advantages in using compact free flaps with short pedicle lengths to cover small hand defects.

• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.64-70
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• 1999

Digit that were formerly assessed as non replantable may now be replanted with the help of salvage procedure. In case that, venous repair is either marginal or technically impossible and postoperative venous congestion developed following replantation, are treated with the application of medical leeches. From July 1997 to April 1998, the authors performed arterial anastomosis and venous drainage using medical leeches in 3 children(The age of the patients ranged from 13 months to 6 years.) to have a result of aesthetic and functional success with minimizing the complications. Leech therapy has many advantages, to avoid injuring of finger tip, to decrease focal capillary coagulation, to prevent severe bleeding, and to prevent thromboembolism. The authors conclude that the use of medical leeches shows promise as a safe and effective method of providing temporary venous drainage in replanted digits.

• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.10-14
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• 1999

Ear reconstruction is very difficult to perform and often results in a devastating deformity. The use of microsurgical replantation techniques has allowed very favorable anesthetic results. We report a case of a partial ear replantation without venous repair with the use of medicinal leeches to decompress the acute venous congestion during the postoperative care. The medicinal leech therapy can be very useful in a partial ear replantation in cases with no venous repair.

• Journal of Chest Surgery
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• 제19권2호
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• pp.288-294
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• 1986

During the period from Mar. 1983 to Feb. 1986, 22 patients with vascular trauma were treated at Capital Armed General Hospital. 1] 11 patients had arterial injury alone, 6 patients had venous injury alone, and 5 patients had both arterial and venous injuries. 2] The mechanism of injury in these 22 patients was 7 penetrating non-gun shot wounds, 5 blast fragments injuries, 4 iatrogenic injuries, 4 blunt injuries, 2 gun shot wounds. 3] The method of 16 arterial repair was 5 autogenous saphenous vein graft, 8 synthetic vascular graft, 1 end to end anastomosis, 2 lateral suture. Midterm patency of 16 repairs was 100% within 1 months. 4] The method of 11 venous repair was 1 autogenous saphenous vein graft, 2 onlay vein patch, 2 ligation, 1 lateral suture. The thrombotic obstructions occurred in 4 repairs [36.4%], but they were resolved somewhat with heparinization. 5] Uncommon cases of false aneurysm of internal carotid artery and laceration of retrohepatic inferior vena cava were summarized.